As social enterprise and third sector organisations have become more central to traditional public sector provision in Wales, there has been increased use in rural areas of multi-agency teams to deliver services. This paper draws on a study of twenty projects delivered under the auspices of NHS Wales and the first implementation phase of the Rural Health Plan (2010-11); key themes of which include access, integration and, community cohesion and engagement. The need for speed of induced innovation emphasises reactivity in some instances and transfer of practices from more developed (or urban) environments to rural communities without acknowledgement of cultural, social and economic contexts and conditions. Inclusion of social enterprise practitioners, particularly those with community development and capacity building expertise in co-production of services may allow for the development of integrated and innovative working across health and social care, which may also be more aligned with a Welsh focus on prudent healthcare. In this respect, the paper considers the role of social enterprise in identifying and fostering innovation in low income, rural areas in ways that provide close-to-patient/service user services and address local issues and health determinants to provide more sustainable and resilient community based health and social care provision.